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Vol. 123, No. 2, 2012
Issue release date: November 2012
Cardiology 2012;123:103–107

A Case of Fatal Fulminant Myocarditis Presenting as an Acute ST-Segment Elevation Myocardial Infarction and Persistent Ventricular Tachyarrhythmia Associated with Influenza A (H1N1) Virus in a Previously Healthy Pregnant Woman

Ona M.A. · Bashari D.R. · Tharayil Z. · Charlot A. · Hoskins I. · Timoney M. · Usmani S. · Royzman R.
Departments of aInternal Medicine, bObstetrics and Gynecology, cSurgery and dEmergency Medicine, Lutheran Medical Center, and eNew York City Office of Chief Medical Examiner, Brooklyn, N.Y., USA

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Several studies have reported influenza A (H1N1) virus as a cause of fulminant myocarditis. We report the first fatal case of fulminant myocarditis presenting as an acute ST-segment elevation myocardial infarction and ventricular tachyarrhythmia associated with influenza A (H1N1) in a previously healthy pregnant woman. A 38-year-old Asian woman, gravida 3, para 1-0-1-1, presented with flu-like symptoms. Initially, she developed wide-complex tachycardia requiring several defibrillations and was later intubated. Electrocardiogram showed ST-segment elevation. Coronary angiogram was negative and a pulmonary angiogram ruled out pulmonary embolism. Fetal compromise was noted on the monitor, and the patient underwent an emergent cesarean section. She subsequently expired. Autopsy confirmed severe myocarditis. Further testing confirmed influenza A (H1N1) virus. This case of a rare, yet lethal, complication of H1N1 infection underscores the importance of increased awareness among health care professionals to provide pregnant women with vaccination and prompt treatment.

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